Left ventricular systolic dysfunction is associated with poor functional outcomes after endovascular thrombectomy

Area of Science:

• Cardiology
• Neurology
• Stroke Medicine

Background:

• Endovascular thrombectomy (ET) has revolutionized acute ischemic stroke (AIS) treatment for large vessel occlusion (LVO).
• Left ventricular systolic dysfunction (LVSD) can impair cerebral blood flow, potentially affecting stroke outcomes.
• The impact of LVSD on patients undergoing ET for anterior circulation LVO requires further investigation.

Purpose of the Study:

• To evaluate the relationship between LVSD, assessed by left ventricular ejection fraction (LVEF), and clinical outcomes in AIS patients with anterior circulation LVO treated with ET.
• To identify predictors of functional outcomes following ET in this patient population.

Main Methods:

• A multicenter retrospective cohort study involving 440 AIS patients with LVO who underwent ET.
• LVSD was defined as LVEF <50%, measured using echocardiography.
• The primary outcome was a good functional outcome (modified Rankin Scale [mRS] 0-2) at 3 months.

Main Results:

• LVSD was an independent predictor of poor functional outcomes at 3 months post-ET (OR 2.08, 95% CI 1.18 to 3.68; p=0.011).
• Unsuccessful reperfusion (TICI grade 0-2a) and pre-existing diabetes mellitus were also associated with poorer outcomes.
• LVSD showed an unfavorable shift in mRS outcomes (OR 2.32, 95% CI 1.52 to 3.53; p<0.001) after adjustment.

Conclusions:

• Patients with anterior circulation LVO AIS and LVSD experience worse outcomes after ET.
• Cardiac factors, including LVSD, should be considered in the management, monitoring, and prognostication of stroke patients undergoing ET.
• Further research may explore targeted cardiac interventions to improve outcomes in these patients.